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Date of Graduation
Doctor of Nursing Practice (DNP)
School of Nursing
Background: Hepatitis C virus (HCV) is a silent epidemic affecting a vulnerable patient population in our society. Among those considered high risk for having HCV are those individuals born between 1945 and 1965, termed the baby boomer population. Baby boomers are five times more likely to have and suffer mortality from HCV than any other patient population (CDC, 2018). HCV may not present with signs or symptoms until 20 to 30 years post contraction of the virus (CDC, 2018). In 2012, the Centers for Disease Control and Prevention (CDC) updated its recommendations for Hepatitis C screenings to include the baby boomer population (Guo & Sims, 2017). Despite the CDC recommendation, it is estimated that an average of 13% of baby boomers have been screened (Kasting et al., 2018). The purpose of this quality improvement project was to increase HCV screenings in the baby boomer population in outpatient family practice by providing clinical staff awareness of the need to screen.
Methods: A retrospective chart review was conducted by utilizing the Epic electronic health record (EHR) system, to determine the number of current patients born between 1945 and 1965 who had not been diagnosed or previously screened for HCV. Data was entered in “REDCap,” a web application that supports data collection (REDCap, 2019). Patients were linked by a unique patient identification number. Patient data collected included; age, sex, year of birth, race, date of screening, zip code, HCV test result, insurance, visit type (lab versus provider), screened/not screened. If not screened, the reason is given if it was provided by the patient. Clinical nursing staff pre and post-test results from the HCV education evaluation were uploaded in REDCap. The Plan, Do, Study, Act (PDSA) Cycle served as the framework for this 12-week project. The theoretical frameworks guiding this project were The Institute for Healthcare Improvement (IHI) Triple Aim and The Health Belief Model (HBM).
Intervention: HCV education was provided to clinical staff to detail the importance of and evaluate their basic knowledge of HCV facts and screening in the 1945 to 1965 patient population. Patients who had not been previously screened were identified on the provider and lab schedules. HCV education was provided to patients at the clinical visit. If the patient consented, an HCV antibody screening test was ordered.
Results: HCV screenings increased 82% for the project period. HCV screening rates in the baby boomer population for the practice increased from 31% to 42% by project end, suggesting that the clinical staff’s educational intervention increased the awareness of HCV, thus increasing screening rates for the practice. Screening rates decreased monthly following the educational intervention, suggesting that there may have been decreased motivation by staff to screen and additionally indicating the need for re-education at regular intervals.
Muse Nakoda, Betina, "Improving Hepatitis C screenings in the 1945 to 1965 birth cohort in outpatient primary care" (2019). Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019. 24.